Initiating quadruple therapy with an SGLT2 inhibitor in newly diagnosed HFrEF patients was associated with a lower rate of HF decompensation at 6 months compared to non-use (5.2% vs 13.4%, p=0.006).
Cohort (n=518)
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Does early initiation of an SGLT2 inhibitor reduce heart failure decompensation and improve treatment optimization in newly diagnosed HFrEF patients?
Early initiation of SGLT2 inhibitors in de novo HFrEF patients is associated with improved optimization of quadruple therapy and reduced short-term heart failure decompensations.
Tasa de eventos absoluta: 5.2% vs 13.4%
valor p: p=0.006
Abstract Introduction Current clinical guidelines recommend quadruple therapy for heart failure (HF) patients and reduced ejection fraction (HFrEF). However, there is limited evidence regarding the optimal sequence for initiating treatment. Objective This study investigates whether initiating quadruple therapy with an SGLT2 inhibitor (SGLT2i) offers advantages over other treatment sequences. Methods This prospective, multicenter study was conducted across 32 centres nationwide. We included newly diagnosed patients with HFrEF (LVEF≤40% at diagnosis) with 6 months of follow-up. The initial treatment schedule, including SGLT2i use and the schedule of up-titration, was at the discretion of the treating cardiologist. We compared patients who started with an SGLT2i in their baseline therapy with those who did not. We also analyzed titration patterns, treatment optimization, and clinical events during the follow-up period. Results A total of 518 patients were included. Of these, 400 (77.2%) began treatment with an SGLT2i, while 100 did not. The two groups had no significant differences regarding comorbidities, including diabetes and chronic kidney disease (table 1). Patients who started with an SGLT2i were more likely to also initiate treatment with a mineralocorticoid receptor antagonist (MRA), with no differences in the other drugs of the quadruple therapy regimen. At 6 months, a higher proportion of patients who started with an SGLT2i were on quadruple therapy, with a higher prevalence of renin-angiotensin-aldosterone inhibitors or MRA use. The percentage of patients achieving target doses was similar across both treatment regimens (table 1). At 6 months, 31 patients (7%) experienced any HF decompensation, with a significantly higher rate in the non-SGLT2i group (13.4% vs 5.2%, p=0.006). No significant differences were observed in all cardiovascular events (22.7% vs 17.5%, p=0.247), non-cardiovascular events (30.9% vs 26.8%), or mortality (4.3% vs 2.0%, p=0.182). Survival analysis showed that patients who started with an SGLT2i had fewer readmissions or emergency room visits due to HF decompensation (figure 1). Conclusions Our findings suggest that early initiation of SGLT2i as part of quadruple therapy is associated with better treatment adherence, maintenance of target doses, and a more favourable clinical profile, with fewer HF decompensations than other treatment sequences.Table 1 Figure 1
Fernandez et al. (Sat,) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=518). SGLT2 inhibitor vs. No initial SGLT2 inhibitor was evaluated on Any HF decompensation (p=0.006). Initiating quadruple therapy with an SGLT2 inhibitor in newly diagnosed HFrEF patients was associated with a lower rate of HF decompensation at 6 months compared to non-use (5.2% vs 13.4%, p=0.006).